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Is Obamacare Helping Anyone Stay Healthy?

by Brian T. Lynch, MSW

Let’s say you really want to know if Obamacare has had a positive effects on keeping people healthy. Partisan politics makes it difficult to get any concrete or objective answers to this or any questions regarding the Affordable Care Act (ACA). So how would you go about finding the answer?

You could find out by designing your own study. You might start by looking at diseases that are silent killers because these have permanently damaging effects long before there are physical symptoms.

Diabetes is just such a disease. According to medical sources, as many as one person in four have diabetes and don’t know it. The longer it goes undetected the more it damages your internal organs, yet a simple blood test and doctors visit is all it takes to uncover and control this disease.

Now imagine that you have results of 400,000 diabetes blood tests nationwide from which you could pull out all the newly diagnosed cases. First you sort the new case in 2013, before any Medicaid expansion, from the 2014 cases after the expansion. Next you sort the new diabetes cases from each period by the 26 states that expanded Medicaid from the 24 states that refused. A concrete measure of an improved healthcare outcome would be finding that there was an increased rate of diabetes detection in the expansion states over the non-expansion states.

Just such a study was done and published this week (March 21, 2015) by Qwest Diagnostics, a national medical laboratory. What their analysis discovered was a 23% increase of newly diagnosed cases of diabetes in the states that expanded Medicaid in 2014. There was only a 0.4% increase in new diabetes cases from states that did not expand Medicaid. What’s more, they were able to see a trend towards earlier detection of diabetes in the expansion states. Earlier detection means fewer heart attacks, strokes, kidney transplants, amputations, blindness and premature deaths. This, in turn, means a healthier population and lower health care costs over time.

Thousands of people will now lead healthier lives and live to their full potent in those 26 states that expanded Medicaid under the ACA. The number of people who could have been covered by the expansion roughly equals the number who got coverage in 2014. This means an almost equal number of people will likely experience needlessly declining health due to undiagnosed diabetes. The states that don’t expand Medicaid will have higher healthcare costs in the future resulting from a less healthy population.

The news isn’t all bleak for the poor or elderly in states that didn’t expand Medicaid. A report by the Avalere Health organization recently found that there are 550,000 new enrollees in standard Medicaid in 15 states that have not expanded Medicaid. They attribute this rise in enrollment to the “woodwork effect,” caused by increased public awareness and publicity surrounding Obamacare. These are individuals who were eligible for standard Medicaid but hadn’t applied. It is safe to presume that some of them will benefit from the early detection of diabetes.

From this one Quest diagnostics study alone the answer is clear. The Affordable Care Act is having a positive effect on the health and well-being of citizens in those states that expanded Medicaid. There are other silent killers that can easily be detected early while treatments and cures are still possible, such as high blood pressure and many types of cancer. If earlier detection of these diseases are also resulting from Medicaid expansion, this would be overwhelming evidence that the ACA is improving health outcomes.

Expanding Medicaid doesn’t cost the states any additional revenue for the first few years. After that there is significant reimbursements from the Federal Government. Refusing Medicaid expansion actually costs states millions of dollars in uncompensated care right now. Doing this on ideological grounds is not a principled position, not when it clearly results in a less healthy population and increased medical expenses for the foreseeable future.

I close with a quote from the actual Quest Diagnostics study findings:

Actual Study Findings:

“We identified 215,398 and 218,890 patients who met our definition of newly diagnosed diabetes within the first 6 months of 2013 (control period) and 2014 (study period), respectively (a 1.6% increase). We identified 26,237 Medicaid enrolled patients with new diabetes in the control period vs. 29,673 in the study period: an increase of 13%. The number of Medicaid-enrolled patients with newly identified diabetes increased by 23% (14,625 vs. 18,020 patients) in the 26 states (and District of Columbia) that expanded Medicaid compared with an increase of 0.4% (11,612 vs. 11,653 patients) in the 24 states that did not expand Medicaid during this period. Similar differences were observed in younger and older adults and for both men and women.”

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Quest Diagnostics Diabetes Study: http://care.diabetesjournals.org/content/early/2015/03/19/dc14-2334.full.pdf+html

Avalere Health Report: http://avalere.com/expertise/managed-care/insights/avalere-analysis-medicaid-non-expansion-states-experience-up-to-10-enrollme

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More Evidence Organically Grown Food is Healthier

by Brian T. Lynch, MSW

More and more people are looking to purchase organic foods in the belief that organically grown food is healthier. There has been growing concern about possible health impacts from the agrochemicals used in traditional crop production. These chemicals have included pesticides growth regulators and various petrochemical fertilizers. Many of these synthetic chemicals are not permitted in organically grown food. This often requires organic farmers to adopt different methods of crop production including mechanical weeding and different schedules of crop rotation. The question has been whether the absence of agrochemicals and the differing methods of food production actually produce safer or more nutritious crops.

A recent meta-analysis of 343 peer reviewed studies was published in the British Journal of Nutrition. This analysis uncovered that there are indeed significant differences between organically grown and traditionally grown crops. It was found that organically grown crops have higher antioxidants and lower concentrations of trace metals such as cadmium. I higher intake of antioxidants, such as those found in organic foods in this study, have been found to reduce the risk of cardiovascular disease and certain types of cancer such as colon cancer. Antioxidants have also been linked to a lower risk of certain degenerative neurological conditions.  Low dose, long-term exposure to cadmium can be damaging to the kidneys and can lead to the formation of kidney stones.[http://www.epa.gov/osw/hazard/wastemin/minimize/factshts/cadmium.pdf]

For more detailed information on this study the abstract has been appended below along with a link to the original study.

News that organically grown food is richer in antioxidants is especially encouraging news since there continues to be little evidence that antioxidant supplements have a beneficial effect on health. it appears that not all substances with antioxidant properties have beneficial effects, and in some cases the effects of certain anti-oxidant chemicals can be harmful. What seems to be important for receiving health benefits from antioxidant substances is to obtain them through fresh fruits and vegetables rather than through supplements.

The school of Public health at Harvard has published a good review of the benefits of antioxidants, the just of which reads:

Free radicals contribute to chronic diseases from cancer to heart disease and Alzheimer’s disease to vision loss. This doesn’t automatically mean that substances with antioxidant properties will fix the problem, especially not when they are taken out of their natural context. The studies so far are inconclusive, but generally don’t provide strong evidence that antioxidant supplements have a substantial impact on disease. But keep in mind that most of the trials conducted up to now have had fundamental limitations due to their relatively short duration and having been conducted in persons with existing disease. That a benefit of beta-carotene on cognitive function was seen in the Physicians’ Health Follow-up Study only after 18 years of follow-up is sobering, since no other trial has continued for so long. At the same time, abundant evidence suggests that eating whole fruits, vegetables, and whole grains—all rich in networks of antioxidants and their helper molecules—provides protection against many of these scourges of aging. [ http://www.hsph.harvard.edu/nutritionsource/antioxidants/ ]

 
British Journal of Nutrition
 
Higher antioxidant and lower cadmium concentrations and lower incidence
of pesticide residues in organically grown crops: a systematic literature
review and meta-analyses

Abstract;

Demand for organic foods is partially driven by consumers’ perceptions that they are more nutritious. However, scientific opinion is divided on whether there are significant nutritional differences between organic and non-organic foods, and two recent reviews have concluded that there are no differences.

In the present study, we carried out meta-analyses based on 343 peer-reviewed publications that indicate statistically significant and meaningful differences in composition between organic and non-organic crops/crop-based foods.

Most importantly, the concentrations of a range of antioxidants such as polyphenolics were found to be substantially higher in organic crops/crop-based foods, with those of phenolic acids, flavanones, stilbenes, flavones, flavonols and anthocyanins being an estimated 19 (95 % CI 5, 33) %, 69 (95 % CI 13, 125) %, 28 (95 % CI 12, 44) %, 26 (95 % CI 3, 48) %, 50 (95 % CI 28, 72) % and 51 (95 % CI 17, 86) % higher, respectively.

Many of these compounds have previously been linked to a reduced risk of chronic diseases, including CVD and neurodegenerative diseases and certain cancers, in dietary intervention and epidemiological studies. Additionally, the frequency of occurrence of pesticide residues was found to be four times higher in conventional crops, which also contained significantly higher concentrations of the toxic metal Cd.

Significant differences were also detected for some other (e.g. minerals and vitamins) compounds. There is evidence that higher antioxidant concentrations and lower Cd concentrations are linked to specific agronomic practices (e.g. non-use of mineral N and P fertilisers, respectively) prescribed in organic farming systems. In conclusion, organic crops, on average, have higher concentrations of antioxidants, lower concentrations of Cd and a lower incidence of pesticide residues than the non-organic comparators across regions and production seasons.

[ http://csanr.wsu.edu/m2m/papers/organic_meta_analysis/bjn_2014_full_paper.pdf ]

The Authors 2014. The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution licence http://creativecommons.org/licenses/by/3.0/

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Image credit: http://upload.wikimedia.org/wikipedia/commons/2/2f/Culinary_fruits_front_view.jpg

New Employment and Health Care Stats Refutes Obamacare Opponents

by Brian T. Lynch, MSW

 The latest labor statistics and health care statistics refute the false claims being made against the Affordable Care Act (ACA) by Obamacare opponents. The claims and facts below are summarized from an excellent op/ed in Forbes magazine by Rick Ungar, which can be found here: 

 CLAIM: Obamacare will lead to a decline in full-time employment as employers reduce hours to below 30 per week to avoid providing health benefits.

 FACT: Numbers just released by the  Bureau of Labor Statistics (BLS), shows that part-time workers in the U.S. fell by 300,000 since the Affordable Care Act became law.  This past year, the first full year of Obamacare health coverage, full-time employment grew by over 2 million.  Part-time employment leaders who oppose Obamacare.  Fewer cops, fewer teachers, fewer folks providing essential social services in the public sector  all to make political point.

CLAIM: Millions of Americans are losing their individual health insurance policy due to Obamacare.

FACT:   A new study  by Lisa Clemans-Cope and Nathaniel Anderson of the Urban Institute found that prior to the Affordable Care Act the number of people kept their individual policy was very low with just 17 percent retaining coverage for more than two years.”  The Urban Institute conducted a survey last December that asked 522 people between the ages of 18 and 64,  “Did you receive a notice in the past few months from a health insurance company saying that your policy is cancelled or will no longer be offered at the end of 2013?” Only 18.6% said their plan was cancelled because it didn’t meet ACA coverage requirements, while the expected cancellation rate was 17% in the years prior to Obamacare. You can find the following bar graph and read more  in Health Affairs.

Obamacare Survey Bar Graph

The 18.6 percent who lost individual health insurance coverage due to the ACA requirements amounts to about 2.6 million people. According to the Urban Institute researchers over half of these folks will  be eligible for coverage assistance. Still, roughly one million people will have to replace their cancelled policy with something that may cost them more. This isn’t good but it is less dramatic than what has been reported and most of these individuals would have been in the same boat prior to the ACA.

Facts matter – The Gallup-Healthways Well-Being Index was also just released. It reveals that 15.9 percent of American adults are now uninsured, down from 17.1 percent for the last three months of 2013.  That translates roughly to 3 million to 4 million people getting coverage who did not have it before.  The the number of Americans who still do not have health insurance coverage is on track to reach the lowest quarterly number since 2008.

There are currently 5 to 8 million people who can’t access Medicaid because their political leaders oppose Obamacare. That means the number of people being denied access to Medicaid expansion for political reasons is greater than the number who have signed up for Obamacare so far.  The Rand Corporation recently analyzed 14 of the states with governors who oppose the Medicaid expansion and found their actions will deprive 3.6 million people of health coverage under Obamacare. These states will forgo $8.4 billion in federal funding. Moreover, their political opposition to Obamacare will cost these states $1 billion for programs that partially compensate medical providers who care for the indigent. (see Huffington Post: http://www.huffingtonpost.com/2013/06/03/medicaid-expansion_n_3367301.html). 

 Below is an excerpt and table of the uninsured by state that is taken from the Health Affairs Blog, which you can goto at: http://healthaffairs.org/blog/2014/01/30/opting-out-of-medicaid-expansion-the-health-and-financial-impacts/

 Clearly, if the extreme efforts underway to by politicians to derail the Affordable Care Act was instead focused towards making it work, Obamacare would be wildly successful. 

Examining the numbers. The number of uninsured people in states opting in and opting out of Medicaid expansion is displayed in Exhibit 1. Nationwide, 47,950,687 people were uninsured in 2012; the number of uninsured is expected to decrease by about 16 million after implementation of the ACA, leaving 32,202,633 uninsured.  Nearly 8 million of these remaining uninsured would have gotten coverage had their state opted in.  States opting in to Medicaid expansion will experience a decrease of 48.9 percent in their uninsured population versus an 18.1 percent decrease in opt-out states. 

Exhibit 1: Uninsured Population by State, Pre- and Post-ACA 

Dickman-Exhibit 1

Here is a link to a website where you can check out state-by-state enrollments using an inter-active map: https://www.statereforum.org/tracking-health-coverage-enrollment-by-state?gclid=COCG7ffPob0CFYt9OgodPTQALQ

 And this link is to an inter-active map showing the state-by-state status on Medicaid expansion: https://www.statereforum.org/Medicaid-Expansion-Decisions-Map?gclid=CJ_i4L3Rob0CFYuXOgod2RMA4g

Obamacare – Is It For Good or Evil?

Like anything else, you can use a thing or abuse it. The Affordable Care Act is being shredded for political reasons in many states to create proof that it doesn’t work. It’s a shambles in the hands of those who want to use it as a cudgel with which to beat up Obama.  More enlightened states are taking every advantage of the ACA and in doing so they are better serving their citizens and improving their state budgets. Here below is a snippet from an article in the Washington Post:

How we got Obamacare to work

By Jay Inslee, Steve Beshear and Dannel P. Malloy, Published: Washington Post, November 17, 2012

http://www.washingtonpost.com/opinions/how-we-got-obamacare-to-work/2013/11/17/3f2532bc-4e42-11e3-be6b-d3d28122e6d4_story.html

[snip]  In our states — Washington, Kentucky and Connecticut — the Affordable Care Act, or “Obamacare,” is working. Tens of thousands of our residents have enrolled in affordable health-care coverage. Many of them could not get insurance before the law was enacted.

People keep asking us why our states have been successful. Here’s a hint: It’s not about our Web sites.

Sure, having functioning Web sites for our health-care exchanges makes the job of meeting the enormous demand for affordable coverage much easier, but each of our state Web sites has had its share of technical glitches. As we have demonstrated on a near-daily basis, Web sites can continually be improved to meet consumers’ needs.

The Affordable Care Act has been successful in our states because our political and community leaders grasped the importance of expanding health-care coverage and have avoided the temptation to use health-care reform as a political football.

In Washington, the legislature authorized Medicaid expansion with overwhelmingly bipartisan votes in the House and Senate this summer because legislators understood that it could help create more than 10,000 jobs, save more than $300 million for the state in the first 18 months, and, most important, provide several hundred thousand uninsured Washingtonians with health coverage.

In Kentucky, two independent studies showed that the Bluegrass State couldn’t afford not to expand Medicaid. Expansion offered huge savings in the state budget and is expected to create 17,000 jobs.

In Connecticut, more than 50 percent of enrollment in the state exchange, Access Health CT, is for private health insurance. The Connecticut exchange has a customer satisfaction level of 96.5 percent, according to a survey of users in October, with more than 82 percent of enrollees either “extremely likely” or “very likely” to recommend the exchange to a colleague or friend.

In our states, elected leaders have decided to put people, not politics, first.

[Read more here: http://www.washingtonpost.com/opinions/how-we-got-obamacare-to-work/2013/11/17/3f2532bc-4e42-11e3-be6b-d3d28122e6d4_story.html ]

_______________ … _______________

If you feel  that the media isn’t doing a good job of covering the positive side this story and isn’t reaching the ACA doubters and haters you know, then do something about it. Point them to this article or refer them here to read something that is directly from the chief executives of states where the ACA is working.

Snip-Its: Why Exercise Improves Health

Here is information about a study on how exercise bio-chemically improves our physical health. This article caused me to jumped on my Treadmill and subsequently join a gym.  From a bio-chemical perspective it seems that a little physical exercize initates a cellular process analogous to recycling the trash that builds up in our cell bodies.  

Just why exercise is so good for people is, at last, being understood

Jan 21st 2012 | from the print edition

http://econ.st/z0Fc6U

ONE sure giveaway of quack medicine is the claim that a product can treat any ailment. There are, sadly, no panaceas. But some things come close, and exercise is one of them.  [snip]
[A] paper just published in Nature by Beth Levine of the University of Texas Southwestern Medical Centre and her colleagues sheds some light on the matter. [snip]
Dr Levine and her team were testing a theory that exercise works its magic, at least in part, by promoting autophagy. This process, whose name is derived from the Greek for “self-eating”, is a mechanism by which surplus, worn-out or malformed proteins and other cellular components are broken up for scrap and recycled. [snip]
The virtues of recycling
Autophagy is an ancient mechanism, shared by all eukaryotic organisms (those which, unlike bacteria, keep their DNA in a membrane-bound nucleus within their cells). It probably arose as an adaptation to scarcity of nutrients. Critters that can recycle parts of themselves for fuel are better able to cope with lean times than those that cannot. But over the past couple of decades, autophagy has also been shown to be involved in things as diverse as fighting bacterial infections and slowing the onset of neurological conditions like Alzheimer’s and Huntington’s diseases.
Most intriguingly of all, it seems that it can slow the process of ageing. [snip]
The theory is that what are being disposed of in particular are worn-out mitochondria. These structures are a cell’s power-packs. They are where glucose and oxygen react together to release energy. Such reactions, though, often create damaging oxygen-rich molecules called free radicals, which are thought to be one of the driving forces of ageing. Getting rid of wonky mitochondria would reduce free-radical production and might thus slow down ageing. [Stop]
Read full article here:  http://econ.st/z0Fc6U

Obesity, Metabolic Disease and Pathways to a Cure

What follows is my abridged version of one of the most significant summaries of research into diet and human health.  This article was written by Moises Velasquez-Manoff  for Mother Jones in April of 2013. When you go to the full text of this article you will also find a video and other helpful information.  The focus of this abridgement is to present the key advances in our understanding of diet, obesity and metabolic syndrome.  Omitted are the implications and recommendations with respect to dietary changes. I would recommend that you read the full article at Mother Jones. The URL Web address is below.

Are Happy Gut Bacteria Key to Weight Loss?

by Moises Velasquez-Manoff

[Abridged version for readers of DataDrivenViewPoints.com]

MOTHER JONES – April 22, 2013

http://m.motherjones.com/environment/2013/04/gut-microbiome-bacteria-weight-loss

Highest-Calorie-Foods

In 2004 a curious diabetes specialist in Buffalo, New York, named Dr. Paresh Dandona, fed nine normal-weight volunteers an egg sandwich with cheese and ham, a sausage muffin sandwich, and two hash brown patties to see what effect this had on their bodies.

He found that levels of a C-reactive protein, an indicator of systemic inflammation, shot up “within literally minutes,” and remained elevated for hours. Inflammation is a natural and important part of our immune system response, but inflammation can also cause collateral damage, especially when the response is overwhelming—like in septic shock—or when it goes on too long.

Chronic, low-grade inflammation has long been recognized as a feature of metabolic syndrome, a cluster of dysfunctions that tends to precede full-blown diabetes and that also increases the risk of heart disease, stroke, certain cancers, and even dementia—the top killers of the developed world. The syndrome includes a combination of elevated blood sugar and high blood pressure, low “good” cholesterol, and an abdominal cavity filled with fat, often indicated by a “beer belly.” Could chronic systemic inflammation (CSI), in fact, be a major cause of metabolic syndrome disorder? A fast-food breakfast inflamed, he found, but a high-fiber breakfast with lots of fruit did not. A breakthrough came in 2007 when he discovered that while sugar water, a stand-in for soda, caused inflammation, orange juice—even though it contains plenty of sugar—didn’t.

This time, along with their two-sandwich, two-hash-brown, 910-calorie breakfast, one-third of his volunteers—10 in total—quaffed a glass of fresh OJ. The non-juice drinkers, half of whom drank sugar water, and the other half plain water, had the expected response—inflammation and elevated blood sugar. But the OJ drinkers had neither elevated blood sugar nor inflammation. The juice seemed to shield their metabolism. “It just switched off the whole damn thing,” Dandona says. Other scientists have since confirmed that OJ has a strong anti-inflammatory effect.

What caught Dandona’s attention was increased blood levels of a substance called endotoxin. This molecule comes from the outer walls of certain bacteria. If endotoxin levels rise, our immune system perceives a threat and responds with inflammation. Where had the endotoxin come from? We all carry a few pounds’ worth of microbes in our gut, a complex ecosystem collectively called the microbiota. The endotoxin, Dandona suspected, originated in this native colony of microbes. Somehow, a greasy meal full of refined carbohydrates ushered it from the gut, where it was always present but didn’t necessarily cause harm, into the bloodstream, where it did. But orange juice stopped that translocation cold.

If what some scientists now suspect about the interplay of food and intestinal microbes pans out, it could revolutionize the $66 billion weight loss industry—and help control the soaring $2.7 trillion we spend on health care yearly. “What matters is not how much you eat,” Dandona says, “but what you eat.”

Scientists now suspect that our microbial communities contribute to a number of diseases, from allergic disorders like asthma and hay fever, to inflammatory conditions like Crohn’s disease, to cancer, heart disease, and obesity. As newborns, we encounter our first microbes as we pass through the birth canal. Until that moment, we are 100 percent human. Thereafter, we are, numerically speaking, 10 percent human, and 90 percent microbe. Our microbiome contains at least 150 times more genes, collectively, than our human genome.

The importance of intestinal microbes to our health has grown increasingly evident. Animals raised without microbes essentially lack a functioning immune system. Entire repertoires of white blood cells remain dormant; their intestines don’t develop the proper creases and crypts; their hearts are shrunken; genes in the brain that should be in the “off” position remain stuck “on.” Without their microbes, animals aren’t really “normal.”

Scientists now suspect that our microbial communities contribute to a number of human diseases, from allergic disorders like asthma and hay fever, to inflammatory conditions like Crohn’s disease, to cancer, heart disease, and obesity. As newborns, we encounter our first microbes as we pass through the birth canal. Until that moment, we are 100 percent human. Thereafter, we are, numerically speaking, 10 percent human, and 90 percent microbe. Our microbiome contains at least 150 times more genes, collectively, than our human genome. Sometime in childhood, the bustling community of between 500 and 1,000 species stabilizes.

Our stool is roughly half living bacteria by weight. Every day, food goes in one end and microbes come out the other. The human gut is roughly 26 feet in length. Hammered flat, it would have a surface area of a tennis court. Seventy percent of our immune activity occurs there. The gut has its own nervous system; it contains as many neurons as the spinal cord. About 95 percent of the body’s serotonin, a neurotransmitter usually discussed in the context of depression, is produced in the gut. So the gut isn’t just where we absorb nutrients. It’s also an immune hub and a second brain. And it’s crawling with microbes. They don’t often cross the walls of the intestines into the blood stream, but they nevertheless change how the immune, endocrine, and nervous systems all work on the other side of the intestine wall.

Science doesn’t know exactly what goes wrong with our microbes in disease situations but a loss of intentional microbe diversity appears to correlate with the emergence of illness. Children in the developing world have many more types of microbes than kids in Europe or North America yet develop have fewer allergies and less asthma. In the developed world, children raised in microbially rich environments—with pets, on farms, or attending day care—have a lower risk of allergic disease.

Some studies find that babies born by C-section, deprived of their mother’s vaginal microbes at birth, have a higher risk of celiac disease, Type 1 diabetes, and obesity. Early-life use of antibiotics—which tear through our microbial ecosystems like a forest fire—has also been linked to allergic disease, inflammatory bowel disease, and obesity. Those who study human microbial communities fret that they are undergoing an extinction crisis.

If our microbiota plays a role in keeping us healthy, then how about attacking disease by treating the microbiota? After all, our community of microbes is quite plastic. New members can arrive and take up residence. Old members can get flushed out. Member ratios can shift. So the microbiota represents a huge potential leverage point in our quest to treat, and prevent, chronic disease. In particular, the “forgotten organ,” as some call the microbiota, may hold the key to addressing our single greatest health threat: obesity.

One-third of Americans are now considered overweight, and another third obese. Worldwide, one-fourth of humanity is too heavy, according to the World Health Organization. One-third of Americans are now considered overweight, and another third obese. Worldwide, one-fourth of humanity is too heavy, according to the World Health Organization.

The long-dominant explanation is simply that too little exercise and too many calories equals too much stored fat. The solution: more exercise and a lot more willpower. But there’s a problem with this theory: In the developed world, most of us consume more calories than we really need, but we don’t gain weight proportionally. If you run a daily surplus of just 500 calories you should gain a pound of fat per week, but we either gain weight much more slowly, or don’t gain weight at all.

Some corpulent people, meanwhile, have metabolisms that work fine. Their insulin and blood sugar levels are within normal range. Their livers are healthy, not marbled with fat. And some thin people have metabolic syndrome, often signaled by a beer gut. They suffer from fatty liver, insulin resistance, elevated blood sugar, high blood pressure, and low-grade, systemic inflammation. From a public health perspective, these symptoms are where the real problem lies—not necessarily how well we fit into our jeans.

In one study, mice raised without any intestinal microbes could gorge on food without developing metabolic syndrome or growing obese. But when colonized with their native microbes, these mice quickly became insulin resistant and grew fat, all while eating less food. Another researcher suspected that low-level inflammation might be the cause for this. To prove the principle, he gave mice a low dose of endotoxin, that molecule that resides in the outer walls of certain bacteria. The mice’s livers became insulin resistant; the mice became obese and developed diabetes. A high-fat diet alone produced the same result: Endotoxin leaked into circulation; inflammation took hold; the mice grew fat and diabetic. Then came the bombshell. The mere addition of soluble plant fibers called oligosaccharides, found in things like bananas, garlic, and asparagus, prevented the entire cascade—no endotoxin, no inflammation, and no diabetes. Oligosaccharides are one form of what’s known as a “prebiotic”.

Cani had essentially arrived at the same place as Dandona with his freshly squeezed orange juice. Junk food caused nasty microbes to bloom, and friendly bugs to decline. Permeability of the gut also increased, meaning that microbial byproducts—like that endotoxin—could more easily leak into circulation and spur inflammation. Simply adding prebiotics—in this case, Bifidobacteria—kept the gut tightly sealed, preventing the entire cascade. Our sweet and greasy diet changes gut permeability and alters the makeup of our microbial organ. Our “friendly” community of microbes becomes pathogenic, leaking noxious byproducts where they don’t belong.

Probiotics are bacteria thought to be beneficial to digestion, like the lactobacilli and other bacteria in some yogurts. In the future probiotics might be bacteria derived from those found in Amazonian Indians, rural Africans, even the Amish—people, in other words, who retain a microbial diversity that the rest of us may have lost.

Ultimately, the strongest evidence to support microbial involvement in obesity may come from a procedure that, on the face of it, has nothing to do with microbes: gastric bypass surgery. The surgery, which involves creating a detour around the stomach, is the most effective intervention for morbid obesity—far more effective than dieting.

Originally, scientists thought it worked by limiting food consumption. But it’s increasingly obvious that’s not how the procedure works. The surgery somehow changes expression of thousands of genes in organs throughout the body, resetting the entire metabolism. In March, Lee Kaplan, director of the Massachusetts General Hospital Weight Center in Boston, published a study in Science Translational Medicine showing a substantial microbial contribution to that resetting.

He began with three sets obese mice, all on a high-fat diet. The first set received a sham operation—an incision in the intestine that didn’t really change much, but was meant to control for the possibility that trauma alone could cause weight loss. These mice then resumed their high fat diet. A second set also received a sham operation, but was put on a calorically restricted diet. The third group received gastric bypass surgery, but was then allowed to eat as it pleased. As expected, both the bypass mice and dieted mice lost weight. But only the bypass mice showed normalization of insulin and glucose levels. Without that normalization, says Kaplan, mice and people alike inevitably regain lost weight.

To test the microbial contribution to these outcomes, Kaplan transplanted the microbiota from each set to germ-free mice. Only rodents colonized with microbes from the bypass mice lost weight, while actually eating more than mice colonized with microbes from the other groups. In humans, some studies show a rebound of anti-inflammatory bacteria after gastric-bypass surgery. Dandona has also noted a decline in circulating endotoxin after the procedure. If we understand the mechanism by which the microbiota shifts, he says, perhaps we can induce the changes without surgery.

NOT EVERYONE ACCEPTS that inflammation drives metabolic syndrome and obesity. And even among the idea’s proponents, no one claims that all inflammation emanates from the microbiota. Moreover, if you accept that inflammation contributes to obesity, then you’re obligated to consider all the many ways to become inflamed. The odd thing is, many of them are already implicated in obesity.

Particulate pollution from tailpipes and factories, linked to asthma, heart disease, and obesity, is known to be a cause of inflammation. So is chronic stress. And risk factors may interact with each other: In macaque troops, the high-ranking females, which experience less stress, can eat more junk food without developing metabolic syndrome than the more stressed, lower-ranking females. Epidemiologists have made similar observations in humans. Poorer people suffer the consequences of lousy dietary habits more than do those who are wealthier. The scientists who study this phenomenon call it “status syndrome.”

Exercise, meanwhile, is anti-inflammatory, which may explain why a brisk walk can immediately improve insulin sensitivity. Exercise may also fortify healthy brown fat, which burns off calories rather than storing them, like white fat does. This relationship may explain how physical activity really helps us lose weight. Yes, exercise burns calories, but the amount is often trivial. Just compensating for that bagel you ate for breakfast—roughly 290 calories—requires a 20-minute jog.

Then there’s the brain. Michael Schwartz, director of the Diabetes and Obesity Center of Excellence at the University of Washington in Seattle, has found that the appetite regulation center of the brain—the hypothalamus—is ofteninflamed and damaged in obese people. He can reproduce this damage by feeding mice a high-fat diet; chronic consumption of junk food, it seems, injures this region of the brain. Crucially, the brain inflammation precedes weight gain, suggesting that the injury might cause, or at least contribute to, obesity. In other words, by melting down our appetite control centers, junk food may accelerate its own consumption, sending us into a kind of vicious cycle where we consume more of the poison wreaking havoc on our physiology.

Of course there’s a genetic contribution to obesity. But even here, inflammation rears its head. Some studies suggest that gene variants that increase aspects of immune firepower are over-represented among obese individuals. In past environments, these genes probably helped us fight off infections. In the context of today’s diet, however, they may increase the risk of metabolic syndrome.

Biologically simple, processed foods may cultivate a toxic microbial community, not unlike the algal blooms that result in oceanic “dead zones.” In fact, scientists really do observe a dead zone of sorts when they peer into the obese microbiota. Microbes naturally form communities. In obese people, not only are anti-inflammatory microbes relatively scarce, diversity in general is depleted, and community structure degraded. Microbes that, in ecological parlance, we might call weedy species—the rats and cockroaches of your inner world—scurry around unimpeded. What’s the lesson? Junk food may produce a kind of microbial anarchy. Opportunists flourish as the greater structure collapses. Cooperative members get pushed aside. And you, who both contain and depend on the entire ecosystem, pay the price.

[This abridged version is provided for public use. See https://datadrivenviewpoints.com/fair-use-notice/]

Media Silent on Fukushima Radiation Impact in US

Sometimes the big news stories can only be seen by the shadows they cast. You would think that it would be easy to find detailed updates on the Fukushima disaster’s impact on the fishing industry, milk production, global radiation distribution patterns, etc.  You would be mistaken. The massive media coverage the initial disaster has fallen nearly silent.  Some frustrated environmental advocates have suggested that there may be a media blackout.  Maybe not, but media follow-up stories are few and far between these days.

In July of last year there were major stories about Fukushima and the  plum of radiation reaching across the Pacific Ocean towards North America.  On July 16, 2012, Deborah Dupre of the Examiner reported the following:

“As hair falls out of a Fukushima victim’s head, a new German study reports that North America’s West Coast will be the area most contaminated by Fukushima cesium of all regions in Pacific in 10 years, an “order-of-magnitude higher” than waters off Japan, according to a new German study followed by a former New York Times journalist going inside the no-entry zone and reporting radiation levels over 10 times higher than Tepco’s data.”

The article was accompanied by this scary graphic:

Radioactive Seawater Impact Map

http://www.examiner.com/article/fukushima-west-coast-cesium-slam-ahead-hair-falling-out-tepco-data-flaw?cid=PROD-redesign-right-next

The article went on to say: “”After 10 years, the concentrations become nearly homogeneous over the whole Pacific, with higher values in the east, extending along the North American coast with a maximum (~1 × 10−4) off Baja California,” a new research report states.”

Then, on August 22, 2012, NHK News reported that the Fukushima Daiichi nuclear plant says it has detected radiation 380 times the government safety limit in a fish caught off Fukushima Prefecture.

http://www.forbiddenknowledgetv.com/videos/radiation-poisoning/record-radiation-detected-in-fish-off-fukushima.html

Since then not much else has been reported on the spread of radiation to North America.  It has been reported that tons of debris from the tsunami continues to wash up on the Pacific coast, but very little, especially in the main stream press, about how we are being effected.  http://www.gizmodo.co.uk/2012/12/fukushima-debris-to-keep-hitting-the-pacific-coast-this-winter/

Perhaps my internet search skill are not the best, but the fact that I have to search for follow-up information is a warning sign.  Journalists and the media should paying more attention to to this topic. The one recent article related to radiation fallout from Fukushima I found was a  scientific study published in November, 2012.  It focuses primarily on how tracing  the travel of radionuclides gives insight into atmospheric air circulation in the Northern Hemisphere.

I think we all deserve to know more about what the US, Canadian and Mexican governments are doing to monitor radiation levels, track distribution rates and study how it may be impacting our food supply.

Below is a reference to the recently published study.

Science of The Total Environment Volume 438,

1 November 2012, Pages 80–85

Tracking the complete revolution of surface westerlies over Northern Hemisphere using radionuclides emitted from Fukushima

 M.A. Hernández-Ceballosa, G.H. Hongb, R.L. LozanoaY.I. KimcH.M. Leeb, S.H. Kimb,S.-W. YehdJ.P. Bolívara, ,M. Baskarane

ABSTRACT:

Massive amounts of anthropogenic radionuclides were released from the nuclear reactors located in Fukushima (northeastern Japan) between 12 and 16 March 2011 following the earthquake and tsunami. Ground level air radioactivity was monitored around the globe immediately after the Fukushima accident. This global effort provided a unique opportunity to trace the surface air mass movement at different sites in the Northern Hemisphere. Based on surface air radioactivity measurements around the globe and the air mass backward trajectory analysis of the Fukushima radioactive plume at various places in the Northern Hemisphere by employing the Hybrid Single-Particle Lagrangian Integrated Trajectory model, we show for the first time, that the uninterrupted complete revolution of the mid-latitude Surface Westerlies took place in less than 21 days, with an average zonal velocity of > 60 km/h. The position and circulation time scale of Surface Westerlies are of wide interest to a large number of global researchers including meteorologists, atmospheric researchers and global climate modellers.

http://www.sciencedirect.com/science/article/pii/S0048969712010959